Medical

The Chemistry of Gender and Coming Out in Medical School

“Is it trans or cis?” It’s a question that has tortured many pre-professional students studying organic chemistry for the better part of a century. Effectively learning stereochemistry and its notation really comes down to the permutations of trans, cis, and chiral centers. I think one of my mentors summed it up best when I asked him if he found Organic Chemistry useful in medical school and in his practice as a physician: “Yep, I finally learned how to pronounce all those shampoo ingredients!”
All campy metaphors aside, that phrase has another meaning these days, especially with recent battles over restroom access. When “it” is used in conjunction with gender, the phrase transcends the chemical connotation to instead yield a dehumanizing connotation. “Is it trans or cis?” becomes such a hurtful epithet to describe our identities, but is among far worse and offensive alternatives that are routinely used, sometimes deliberately, sometimes unknowingly.
Dealing with one’s gender dysphoria, pursuing the coming out process, and transitioning one’s gender are all among the most difficult life experiences one might endure. Likewise, transitioning from college or the workforce into a medical school lifestyle is extraordinarily challenging. Now imagine enduring both at the same time: That was me during the fall semester of my second year in medical school.
It all started when I was very young. I knew since I was around 4 years old that my family and friends expected me to behave differently than I felt. I lived my first 12 years in Los Angeles, born as what we now identify as “intersex” at a Kaiser Permanente hospital. In the 1980s through the 1990s, babies like me were instead identified as having “ambiguous genitalia,” neither distinctly male nor female. I was ultimately “designated male at birth” (DMAB) based on my XY chromosomes and the potential to lead my life as a male. I had very painful “corrective genitourinary surgery” when I was 6 years old, without any explanations or information about why I needed the surgery or its consequences. Still, I knew something was different about me as I moved on, from the laughs I endured in the boy’s restroom to being teased for my preference to play with the girls during recess. My experiences, though, are slightly rarer and different from those that are born with distinctly male or female genitals and chromosomes that identify as transgender, which is instead termed as being “assigned male/female at birth” (AMAB/AFAB).
My father and I moved from California to the South in my teens. It was around that time when I found the internet and began to explore. I eventually surmised that I was experiencing gender dysphoria or “gender identity issues” as was the prevalent language at the time. My “condition” was seen as pathological in the 1990s, a far cry from the progressive and embracing practices that we see evolving and spreading today. As such, I secretly explored my emotions and identity in the background during much of high school in the late 90s. But those explorations weren’t nearly as secret as I thought: I was nearly murdered in the rural Southern town in which I graduated during a brutal hate crime committed by several men that heard about my high school gender explorations a year after I graduated. I was approached from behind at a party where the men broke a heavy glass liquor bottle over the back of my head before mercilessly beating me into a bloody pulp in their gravel driveway. Thankfully, two of my friends were driving by at the time, saw the commotion, and stopped to help.
From that day forward, I struggled with severe post-traumatic stress disorder, lingering side effects from my traumatic brain injury, and went into full suppressive mode in terms of my identity. I was far too emotionally vulnerable to accept myself or explore anymore. Even when my gender dysphoria was nearly unbearable, before and during medical school, I was too afraid to overcome denial, to embrace myself and come out, until it boiled over with medical school stress and into suicidal ideation one too many times.
I started medical school with the class of 2018 and was so honored when they elected me as their president in our first year. I helped establish our school’s first lesbian, gay, bisexual, transgender, and queer (LGBTQ) student organization and maintained involvement throughout the ensuing years. I was busy as could be and had a passion to lead. I even decided to come out late in my first year and was planning to make an announcement to our class during our transition to clerkships at the end of our second year. I would be transitioning in a different way and had a unique opportunity to provide our class with real-life teachable moments. But I never did get to make that announcement or pursue those teachable moments…
At the start of our second year, I began to notice some subtle but growing discontent among my peers, a few sneers here, a rude comment or two there, but largely shook it all off as usual medical student stress. That was until the night of the deadline to challenge my presidency came and I was notified that someone chose to run against me at the last minute. Long story short, there were some rumors going around that fueled a campaign to oust me as president, rumors that I was later told involved my gender and sexual orientation. Needless to say, I was devastated and am now no longer our class president.
Nevertheless, through the strength and support of our LGBTQ organization and a few peers, I moved on and decided to come out 100% anyway, first to my administration, then to all of my friends and family. I chose not to make a huge announcement to my peers, but instead told a few to whom I was close, let it run its course, and stopped hiding. I was done hiding.
As I write this today, I’ve been taking anti-androgen medication for a few months now and will begin full hormone replacement therapy (HRT) with added estrogen beginning this time next year, the beginning of my fourth and final year of medical school. Despite the full support of my administration when I came out, I chose to wait to transition to ensure my physical safety and career safety. The LGBTQ progress we’ve seen in the last decade has been reassuring. But being the victim once, and remaining in that same region, I couldn’t take that risk, for better or worse. The when, where, and how of coming out comprise an individual decision that we must all respect and allow to occur on one’s own terms.
I’ve learned a great deal and will continue to learn more as I proceed. I hope that sharing my experience might shed some light on someone’s future decision to come out, or to a professional ally’s understanding of their patients’ struggles. We’re all learning in this together regardless of whether you identify as a cis, heterosexual ally, or somewhere along the LGBTQ’s gender and/or sexual minority (GSM) continuum. The acronyms may be long, the terms confusing, and all of it ever-changing; but being an ally, peer, and friend that’s supportive, eager to learn, and willing to help us effect change can help ensure that future generations will receive the equitable healthcare and respect that we all deserve as humans, regardless of our identities.

G
Guera was born and raised in Los Angeles, educated in the South, and returned to the West for residency training. Self-identified as a genderqueer tra...